Mild to moderate TBI and the role of cervical spine musculoskeletal, and sensorimotor systems.

This programme of research focuses on the function of the cervical spine musculoskeletal (the neck), sensorimotor and autonomic regulatory systems following mild to moderate traumatic brain injury in the context of clinical recovery.

This work is supported by complementary work investigating the relationship between quantifiable impairments across these systems following traumatic brain injury, and functional neuroimaging biomarkers.

This inter-related programme of work is led by Dr Olivia Galea.

Project objectives

Objective 1: The influence of concussion and mild TBI on the cervical spine musculoskeletal, sensory motor and autotonomic systems in the context of clinical recovery.

Following concussion, symptoms most frequently reported include headache, dizziness, and fatigue. Up to 30 percent of those sustaining a concussion will remain symptomatic long after recovery is expected (between 10 days and 1 month depending on age). Those who prolong time between injury and seeking treatment to address their symptoms often have poorer long-term outcomes.

Cohort studies have shown however that body system dysfunction contributing to symptom experience may vary (for example dizziness can stem from cervical spine, vestibular or physiological system disturbances), so selecting treatment based on symptom type may not result in the best outcome for patients. Conversely clinical trials performing physical examinations of patients to select treatment types demonstrate higher levels of treatment benefit. However, these exams are lengthy and can be arduous for patients.

Current projects

• A streamlined approach to identifying adults suited to orthopedic musculoskeletal physiotherapy management acutely following concussion: a feasibility study.

Her current research aims to investigate whether a streamlined physical assessment can identify individuals most suited to neck rehabilitation. This study will concurrently provide preliminary evidence supporting a quantified version of the VOMS assessment to identify those with vestibular dysfunction following concussion. We are currently recruiting for this study at our participant recruitment page.

Funding

2023/24 Stanley Paris Research Fellowship: University of Otago
Total awarded $ 99, 986 NZD

Previous

• Olivia has completed PhD and Postdoctoral studies that have provided the foundation work for this research objective.

Further information and links to her published work can be found on her profile page.

Australian Postgraduate Award/ Research Training Program Scholarship (Australia) $ 108, 404
AUDEyes High Postdoctoral Match-Funding Fellowship: University of Calgary (Canada) $ 50, 000 CAD

Objective 2: Refining clinical tools for assessing cervical spine and sensorimotor impairments

Following traumatic head-neck injuries, as much as 97% of individuals with persistent symptoms and poor long-term outcomes will demonstrate signs of cervical spine or vestibulo-ocular impairment. Use of cervical spine and oculomotor screening tools are commonly used by clinicians to identify such impairments and guide treatment plans. However, many commonly used tools although demonstrating good levels of inter and intra-tester reliability, are yet to validated against more precise measures.

Current projects

• The cervical flexor endurance test: electromyographical validation of the test, old or new.

Mr Michael Culling (Summer Student, 2022/23)
Role: Primary Supervisor
Funding: University of Otago, Division of Health Sciences Summer Studentship Scholarship. Total awarded: $6, 000 NZD
Funding: 2023 School of Physiotherapy: Mark Steptoe Memorial Fund. Total awarded: $ 3, 000 NZD

• Eye head coordination: An imperative sensorimotor function for vision in sport. What happens with increases in head turning velocities?

Mr Cory Glover (PG Masters of Physiotherapy – Clinical)
Role: Primary Supervisor

Publications and Presentations

• Michael Culling, Ihaia Kendrew, Allan Carman, Melanie Bussey, Gisela Sole, Ewan Kennedy, Olivia Galea (2023). Use of Electromyography for Determination of Neck Muscle Fatigue; Can it Strengthen Validity of Clinical Outcome Measures? A Scoping Review. Conference abstract accepted for publication New Zealand Journal of Physiotherapy.
• Galea, O.A., Gray, E.A., Kennedy, E., Dick, M., Quinn, D., Sole, G. (2023). A streamlined approach to identifying adults suited to neck rehabilitation acutely following concussion: Protocol for a feasibility study. Conference abstract accepted for publication in New Zealand Journal of Physiotherapy.
• Olivia A Galea, Kristina E Carberry, Hayden J Cook, David G Fulcher, Catherine A Syme, Julia M Treleaven (2023). Clinical profiles in patients with symptoms four weeks to six months following mild traumatic brain injury. Conference abstract accepted for publication in British Journal of Sports Medicine.
• Galea, O. A.; Liang, Z.; O'Leary S. P.; Trealeaven J. M. (2023). Patterns of cervical musculoskeletal and sensorimotor dysfunction in individuals 4 to 26 weeks post-concussion: a cluster analysis. Conference abstract accepted for publication in British Journal of Sports Medicine.

Collaborators

Prof Gisela Sole (NZ) Researcher CHARR, School of Physiotherapy
Dr. Julia Treleaven (Au) Researcher Head and Neck Research Unit, University of Queensland
Dr. Zhiqi Liang (Au) Researcher Head and Neck Research Unit, University of Queensland
Dr Allan Carman (NZ) Researcher CHARR
A/Prof Melanie Bussey (NZ) School of Physical Education, Sport and Exercise Sciences, UoO
Dr Emily Gray (NZ) Researcher CHARR
A/Prof Shaun O'Leary (Au) Clinician Researcher, Royal Brisbane and Women's Hospital; HANRU, UQ
Dr Ewan Kennedy (NZ) Researcher CHARR
Mr Dusty Quinn (NZ) Researcher CHARR
Mr Matthew Dick (NZ) Physiotherapist, School of Physiotherapy
Mrs Lisa Brits (NZ)
Dr Brett Dougherty (NZ) General Practitioner, Student Health Services, UoO

Student collaborators:
Mr Michael Culling (Otago Medical Research Fund and Department of Health Science Summer Scholarship)
Mr Ihaia Kendrew (Summer student)

Contact

Dr Olivia Galea olivia.galea@otago.ac.nz